La démarche en éthique clinique. Guide pour la mise en place d'une réunion de concertation pluridisciplinaire en éthique

Complicated ethical situations involving either debilitating illness that requires life-sustaining treatments or patients with end-of-life concerns come under the jurisdiction of the law regarding patients and end-of-life care (no 2005-370 of April 22 2005), known as the Leonetti Law. It guarantees all patients, conscious or unconscious (through their power-of-attorney [POA]), the right to ask for the cessation of life-sustaining treatment even if death results. The law also brings forth the notions of unreasonable obstinacy, patient autonomy, and advance directives. It stresses the role of the POA and recommends the institution of meetings to discuss the ethics of each case in the spirit of collegiality and multi-disciplinarity. We are proposing a guide for a step-wise approach to clinical ethics within a health-care team. This clinical ethics approach should be instituted at the request of the referring physician when the patient or the POA (when the patient cannot speak for him or herself) raises the issue of an unreasonable aspect of the existing care. Our approach to clinical ethics consists of four essential successive stages: the contextual analysis of the situation and consideration of the patient's questions, a multidisciplinary ethics consult (MEC), the final decision and an assessment stage as the situation settles down with the development of recommendations in order to improve our ethical practices.